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Partners for Children


Title: Partners for Children Author: jgeigera Last modified by: Windows User Created Date: 9/15/2009 1:23:20 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Partners for Children

Partners for Children
  • Quality Improvement
  • Health Welfare
  • Jill Abramson, MD MPH
  • February15, 2013
  • 2013 Training

PFC Provider Training
  • Overview
  • Care Coordination/CCSNL/Communication
  • Family-Centered Action Plan
  • Services/Billing
  • Quality Improvement /
  • Health Welfare

PFC Quality Improvement
  • PFC QI has these components
  • CMS Assurances
  • Remediation
  • Monitoring (QI reports from agencies)
  • Quality Improvement Strategy

PFC - CMS Improvement
  • Assurances to Centers of Medicare and Medicaid
    Services that State will provide oversight of the
    federal waiver program.

PFC - Assurances
  • Areas
  • Level of Care
  • Service Plan
  • Qualified Providers
  • Health and Welfare
  • Administrative Authority
  • Financial Accountability

PFC - Assurances
  • Enrollment/Level of Care
  • Freedom of Choice
  • Medical eligibility/Level of care
  • criteria met
  • expected 30 days inpatient per year if not for
    PFC waiver or diligence of family
  • LOC form completed at enrollment and annually

PFC - Assurances
  • Service Plan (in F-CAP)
  • Service Plans address Needs including
    Health/Safety risk factors, and Goals
  • Service plans updated at specified intervals
  • Services delivered according to plan

PFC Assurances
  • Qualified Providers
  • Providers meet and adhere to standards
  • Current license, registration
  • Administrative Authority (Medi-Cal exercises
    oversight of waiver functions performed by other
  • Health and Welfare that the client is safely
    living in the home with no abuse, neglect,
  • Financial Accountability

PFC Assurances
  • Participating counties are considered sub-state
    agencies and assist with data entry for

Health Welfare Assurance
  • The State assures that the client is safely
    living in the home with no
  • abuse,
  • neglect,
  • exploitation.

Health and Welfare Training and Education
  • CCSNL Care Coordinator are responsible for
    child and family training and education.

Health and Welfare Training and Education cont.
  • CCSNL discusses and provides the waiver
    enrollment/information packet which contains
  • Description of different types of abuse, neglect,
  • How to recognize if any of these occur and whom
    to contact to report such events/incidents
  • The Care Coordinator will provide additional
    training as necessary.

Care Coordinator Risk Assessment
  • Coordinators risk assessment will address
  • Environmental safety
  • Medical fragility
  • Psychosocial factors
  • Note Upon waiver enrollment, ongoing risk
    assessments will be a part of the Care
    Coordinators responsibility

Environmental Risk Assessment
  • Assurance that the area where the child will be
    cared for can accommodate the use, maintenance,
    and cleaning of all medical devices, equipment,
    and storage supplies necessary to maintain the
    child in the home in comfort and safety, and to
    facilitate the care required.

Environmental Risk Assessment (cont.)
  • Assurance that primary and back-up public
    utility, communication, and fire safety systems
    and devices are available, installed, and in
    working order, including grounded electrical
    outlets, smoke detectors, fire extinguishers,
    carbon monoxide detectors and telephone services.

Environmental Risk Assessment (cont.)
  • Evidence that local emergency and rescue services
    and public utility services have been notified
    that a person with special needs resides in the

Environmental Risk Assessment (cont.)
  • Documentation that the caregivers have been
    trained to support the care needs of the child.
  • Evaluation for risk of abuse, neglect and

Psychosocial Risk Factors
  • Risk for anticipatory grief
  • Isolation from peers
  • Depression
  • Parental distress and burnout
  • The findings must be documented in the F-CAP.

Mitigation of Environmental Risks
  • Families with environmental risk factors
    identified during the assessment will be referred
    to appropriate agencies or community resources.
  • In case of abuse, neglect or exploitation an
    incident report must be filed.

(No Transcript)
Where To Report?
  • In California, all individuals providing or
    monitoring health care are considered mandated
  • Child abuse
  • County Welfare Department (CPS)
  • Probation Department (if designated by the county
    to receive mandated reports)
  • Police or Sheriffs Department
  • Licensing and Certification (LC) who receives,
    responds to, and investigates complaints of
    suspected, alleged, and reported abuse in
    licensed health-care facilities

Where To Report?
  • Dependent adult abuse
  • County Adult Protective Services (APS)
  • Local law enforcement agency.

If the Care Coordinator Receives Initial Complaint
  1. Fill out Event Reporting Form
  2. Report to CPS/APS as required by law
  3. Report to CCSNL
  4. Follow up with Family
  5. Document in childs case file

If the PFC/Waiver Service Provider Receives
Initial Complaint
  • Report to CPS/APS as required by law
  • Tell CC, who reports to CCSNL

(No Transcript)
Responsibility for Oversight of Critical
Incidents and Events
  • In the event of involvement of the Child/Adult
    Health and Welfare system, the CCSNL and Care
    Coordinator will
  • monitor the childs health and safety to ensure
    the issues have been resolved.

Responsibility for Oversight of Critical
Incidents and Events
  • The State Systems of Care Division will partner
    with LC in the oversight of reporting and
    responding to critical incidents or events.

Remediation/Fixing Individual Problems
  • The CCSNL will begin the remediation process
  • Within 2-5 working days (or sooner,
  • To the extent mandated by California
  • law)
  • After discovery of non-compliance, and,

Remediation/Fixing Individual Problems
The CCSNL will begin the remediation process as
it relates to health and welfare sub-assurances,
such as
  • F-CAP does not meet requirements for continuous
    monitoring of environmental assessments, family
    social evaluations or information regarding
    abuse, neglect and exploitation
  • Inappropriate or untimely action occurs in
    response to a report (abuse, neglect,
    exploitation, critical incident or event, etc.)

Remediation (cont.)
  • LC will provide a Complaint Line Notice and a
    contact number for use by all participating
    providers and the public.
  • At the time of waiver enrollment, all staff,
    HHA/HAs and participants will receive
    instructions that any critical event, incident or
    complaint may be reported to the CCSNL, Care
    Coordinator and/or directly to the staff at LC.

Remediation (cont.)
  • The CCSNL or Care Coordinator will also use the
    Event Reporting form to document and report
    concerns, problems, and incidents to ensure
    timely investigation and resolution.

The Event Reporting Form is Designed to Document
  1. The agency and name of the individual completing
    the report, if applicable
  2. The name and CCS number of the participant
  3. The telephone number of the participant and/or
    parent/legal guardian
  4. A description of the event or incident (the who,
    what, when and where)

The Event Reporting Form is Designed to Document
  • Who reported the event or incident
  • The state and local agencies, the treating
    physician, and law enforcement who were notified,
    and when
  • The plan of action to address/resolve the event
    or incident (who, what, when)
  • The resolution and date resolved.

More on Reporting
  • The CC will documentation any reported incident
    in the childs file. If it is determined that
    reporting has not been completed according to
    statutory requirements, an Event Reporting form
    must be completed and forwarded to the
    appropriate agency.
  • The CCSNL will update the childs case file to
    document LCs actions and recommendations and
    the event/incident resolution. During the LC
    investigation, the participant will continue to
    receive necessary services.

PFC Quality Improvement
  • Monitoring (QI reports from agencies)
  • Annual Reports
  • Continuous monitoring of identified areas
  • Quality Improvement Strategy

PFC Provider Training
  • Overview
  • Care Coordination/CCSNL/Communication
  • Family-Centered Action Plan
  • Services/Billing
  • Quality Improvement/ Health Welfare